<?php $this->load->view('layout/header');?>
<div class="supplier-content-page">
    <div class="product-test-h5">
        <ul class="breadcrumb">
            <li><a href="javascript:;">我的账户</a></li>
            <li><a href="<?php echo site_url('accountinfo/accountRecord'); ?>">账户信息</a></li>
            <li class="active"><a href="javascript:;">提现</a></li>
        </ul>
        <?php echo execute_alert_message();?>
        <div class="add-product">
            <form class="public-validate-form form-horizontal" action="<?php echo $this->config->www_base_url.'if/order/ticket.html'?>" method="post">
                <div class="fonter">基本资料</div>
                <div class="form-group">
                    <label class="col-sm-1 control-label"><em>*</em> 提现金额</label>
                    <div class="col-xs-3">
                        <input type="hidden" name="types[]" value="32">
                        <input type="hidden" name="pay_bank" value="99">
                        <input type="hidden" name="cat_id" value="512">
                        <input type="hidden" name="version" value="news">
                        <input type="text" name="nums[]" value="<?php echo $balance->amount_carry; ?>" class="form-control number required" placeholder="请输入您想要提现的金额">
                    </div>
                </div>
                <div class="form-group">
                    <label class="col-sm-1 control-label"><em>*</em> 身份证</label>
                    <div class="col-xs-3">
                        <input type="text" name="sfz" class="form-control required checkcard" placeholder="请输入您真实的身份证号码">
                    </div>
                </div>
                <div class="form-group">
                    <label class="col-sm-1 control-label"><em>*</em> 账号名称</label>
                    <div class="col-xs-3">
                        <input type="text" name="payee_name" class="form-control required" placeholder="请输入您的账号名称">
                    </div>
                </div>
                <div class="form-group">
                    <label class="col-sm-1 control-label"><em>*</em> 银行名称</label>
                    <div class="col-xs-3">
                        <input type="text" name="payee_bank" value="" class="form-control required" placeholder="请输入所属银行">
                    </div>
                </div>
                <div class="form-group">
                    <label class="col-sm-1 control-label"><em>*</em> 银行账号</label>
                    <div class="col-xs-3">
                        <input type="text" name="payee_account" value="" class="form-control required" placeholder="请输入正确的银行账号">
                    </div>
                </div>
                <div class="form-group">
                    <label class="col-sm-1 control-label"><em>*</em> 真实姓名</label>
                    <div class="col-xs-3">
                        <input type="text" name="operator" value="<?php echo $userInfo->contacter; ?>" class="form-control required">
                    </div>
                </div>
                <div class="form-group">
                    <label class="col-sm-1 control-label"><em>*</em> 联系手机</label>
                    <div class="col-xs-3">
                        <input type="text" name="phone" value="<?php echo $userInfo->mobile_phone; ?>" class="form-control required" placeholder="请输入您的手机号码">
                    </div>
                </div>
                <div class="supplierlist-submit">
                    <button type="submit" class="btn btn-default">提现</button>
                    <a href="<?php echo site_url('accountinfo/accountRecord');?>">返回上一级</a>
                </div>
            </form>
        </div>
    </div>
</div>
<?php $this->load->view('layout/footer');?>